1. Field of the Invention
The present invention pertains to suturing of bodily or anatomical tissue and, more particularly, to an apparatus and method for suturing anatomical tissue with suture material attached to a needle and tying the suture material with the same instrument.
2. Discussion of the Related Art
Suturing of bodily tissue, that is, the practice of using lengths of suture material to ligate or approximate tissue, is a time consuming part of most surgical procedures including open surgery, microsurgery and minimally invasive surgery. "Open surgery" refers to surgery wherein the surgeon gains access to the surgical site by a relatively large incision and "minimally invasive surgery" refers to any type of surgery, such as endoscopic surgery or "mini-lap" surgery, wherein the surgeon gains access to the surgical site via one or more portals or small incisions through which instruments, such as forceps, cutters, needle holders and the like, are introduced to the surgical site.
In the past, suturing has been accomplished with the use of a sharp suture needle carrying a length of suture material, the suture needle being caused to penetrate and pass through the tissue pulling the suture material through the tissue. Once the suture material has been pulled through the tissue one or more times, the surgeon ties a knot in the suture material. The knot tying procedure allows the surgeon to adjust the tension on the suture material to accommodate the particular tissue being sutured and to control approximation, occlusion, attachment or other conditions of the tissue.
The process of tissue penetration and tying a knot in the suture material can be time consuming and tedious work, particularly when performed in connection with microsurgery and minimally invasive surgery and can unduly prolong the duration of surgery and therefore the period in which the patient is under anesthesia. Nevertheless, minimally invasive surgery is preferred over open surgery due to the greatly reduced trauma and wound healing time for the patient and due to cost savings associated with shorter hospital stays and performing surgery in non-hospital or outpatient surgery sites. Accordingly, there has been much effort to develop techniques to replace the suturing normally performed by use of a suture needle and a length of suture material. Alternative techniques include electrical coagulation, mechanical devices such as clips, clamps and staples, and lasers.
However, no alternative technique has yet been well accepted by surgeons to produce the results obtained by suturing and knot tying. Thus, there is a great need for suturing and knot tying techniques useful in minimally invasive surgery, open surgery, and microsurgery to permit surgeons to suture anatomical tissue with suture material attached to a needle and tie a knot in the suture material in a time efficient consistent, and precise manner.
The performance of a minimally invasive procedure typically involves creation of one or more puncture sites through a wall of an anatomical cavity using a penetrating instrument including an obturator, such as a trocar, disposed within a portal sleeve. After the penetrating instrument has penetrated into the anatomical cavity, the obturator is withdrawn leaving the sleeve in place to form a portal in the cavity wall for the introduction of instruments having scissors, forceps, needle holders, and the like, into the anatomical cavity. The portal sleeve can be omitted and instruments can be inserted through a very small incision.
Suturing is typically performed with a needle holding instrument, or needle holder, having a needle holding member, such as a pair of jaw members adapted to hold the body of a suture needle. The jaw members of the needle holding instrument are inserted into the cavity and are positioned at the operative site by manipulation of a handle at the proximal end of the instrument outside the body. With a suture needle held between the jaw members of the needle holding instrument, the handle is manipulated to cause a tip of the needle to be pushed through the tissue being sutured. Once the tip of the suture needle has been pushed through the tissue, the jaw members of the needle holding instrument must be opened to release the suture needle so that the tip of the needle can be grasped and pulled through the tissue therewith, or, after opening the jaw members, a second needle holding instrument must be introduced at the operative site through another portal to grasp the tip of the suture needle after it has emerged from the tissue being sutured.
The former technique requires difficult manipulation and further adjustment of the suture needle within the jaw members of the needle holder before another stitch can be made. While use of a second needle holding instrument for pulling the needle through the anatomical tissue allows the first needle holding instrument to grasp the body of the suture needle in the manner required to make additional stitches, a second puncture site is required to permit insertion of the second instrument. It is generally desirable to minimize the number of puncture sites created for performing a particular endoscopic procedure. Because of the difficulty in manipulating a needle and suture material noted above it is difficult to tie a knot in the suture material after suturing, particularly in minimally invasive procedures and open procedures conducted in small spaces or cavities. Several methods of tying suture material, and alternatives to tying suture material, have been proposed.
One approach has been to use a mechanical clamp, sometimes known as a "knotting element", to fix suture material in place after suturing, in leu of tying a knot in the suture material. U.S. Pat. Nos. 5,409,499, 5,474,572, and 5,669,935 all disclose examples of knotting elements. However, knotting elements can be cumbersome to apply and often require additional instruments thus complicating the surgical procedure. Another approach has been to tie a knot externally of the anatomical cavity and to push the knot along suture material into the anatomical cavity with a "knot pusher". Examples of externally tied knotting procedures and instruments therefor are disclosed in U.S. Pat. Nos. 5,391,175, and 5,397,326. However, externally tying the knot requires some means for pushing or guiding the knot into place and renders it difficult to tighten the knot properly to apply the desired tension to the suture material after suturing.
Another approach has been to introduce a single dedicated knot tying instrument, or multiple dedicated knot tying instruments, into the anatomical cavity to tie a knot in suture material. Of course, the use of dedicated knot tying instruments increases the number of instruments and the manual dexterity required for a procedure. Examples of known instruments for tying knots in suture material are disclosed in U.S. Pat. Nos. 5,147,373, 5,336,230, and 5,234,443. However, the instruments and methods of tying a knot disclosed in U.S. Pat. Nos. 5,234,443, 5,147,373, and 5,336,230 require complex manipulation of the suture material with a grasping device. These methods are cumbersome because the suture material must be grasped.